Abdominal and Pelvic Radiology Practice Questions

Q: An adult male presented with abdominal pain and diarrhea. A Barium meal follow-through revealed a mildly narrowed lumen of a loop with stretched and fixed rigid walls. A CT contrast study showed a stellate-shaped, enhancing mesenteric lesion with adjacent bowel wall thickening. What does this mass lesion represent?

Mesenteric carcinoid tumor. ### Explanation The clinical and radiological presentation is classic for a **Mesenteric Carcinoid Tumor**. **1. Why Option B is Correct:** Carcinoid tumors are neuroendocrine neoplasms that frequently secrete serotonin. When these tumors metastasize to the mesentery, they incite a profound **desmoplastic (fibrotic) reaction**. * **CT Findings:** The "stellate" or "spiculated" appearance is pathognomonic, representing a soft-tissue mass with radiating strands of fibrosis that pull on the mesentery. * **Barium Findings:** The serotonin-induced fibrosis causes kinking, tethering, and narrowing of the bowel loops, leading to the "stretched and fixed" appearance described. The enhancement on CT is due to the hypervascular nature of neuroendocrine tumors. **2. Why Other Options are Incorrect:** * **A. Jejunal Adenocarcinoma:** Typically presents as a short-segment, irregular "apple-core" narrowing or a polypoid mass. It does not usually cause a stellate mesenteric mass with extensive desmoplasia. * **C. Lymphoma:** Usually presents as bulky, "sandwich-like" mesenteric lymphadenopathy that encases vessels without causing significant desmoplasia or luminal narrowing. It is typically hypoattenuating and does not show a stellate pattern. * **D. Liposarcoma:** This is a large, fat-containing retroperitoneal mass. While it can displace bowel, it does not produce the specific spiculated, fibrotic mesenteric reaction seen here. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ileum (for midgut carcinoids). * **Carcinoid Syndrome:** Occurs only after liver metastasis (flushing, diarrhea, right-sided heart failure). * **Biomarker:** 24-hour urinary **5-HIAA** (metabolite of serotonin). * **Imaging Sign:** "Spiculated mesenteric mass" = Carcinoid. * **Nuclear Medicine:** **Octreotide scan** (Somatostatin receptor scintigraphy) or Ga-68 DOTATATE PET/CT are the investigations of choice for localization.

Q: A plain radiograph of the chest and abdomen shows findings suggestive of which of the following conditions?

Pneumoperitoneum. ***Pneumoperitoneum*** - **Free air under the diaphragm** on erect chest X-ray is the classic radiological sign of pneumoperitoneum, appearing as a **crescent-shaped lucency**. - Often indicates **bowel perforation** requiring urgent surgical intervention, commonly seen in perforated peptic ulcers or bowel injuries. *Pleural effusion* - Characterized by **blunting of costophrenic angles** and **meniscus sign** on chest X-ray, not free air under diaphragm. - Shows **fluid accumulation** in pleural space, appearing as **homogeneous opacity** in dependent portions of thorax. *Pneumonia* - Presents as **consolidation** or **infiltrates** within lung parenchyma, typically showing **air bronchograms**. - Does not cause **free air under diaphragm**; instead shows **increased opacity** in affected lung segments. *Volvulus* - Shows characteristic **coffee bean sign** or **bird's beak appearance** on abdominal X-ray due to twisted bowel loops. - Associated with **dilated bowel loops** and **air-fluid levels**, but does not produce free air under diaphragm unless perforation occurs.

Q: A 51-year-old male presents with blood-stained stools and abdominal pain. Based on the image shown, what is the most likely diagnosis?

Intussusception. ***Intussusception*** - The **target sign** or **concentric ring sign** on CT imaging is pathognomonic for intussusception, showing the telescoped bowel loops. - In adults, intussusception often has a **lead point** (tumor, polyp) and presents with intermittent abdominal pain and bloody stools. *Crohn's disease* - CT typically shows **bowel wall thickening**, **skip lesions**, and **mesenteric fat stranding** rather than the target sign. - Presents with chronic diarrhea, weight loss, and **transmural inflammation** affecting the terminal ileum most commonly. *Diverticulosis* - CT reveals **outpouchings** of the bowel wall and **diverticular inflammation** if complicated by diverticulitis. - Usually affects the **sigmoid colon** in Western populations and presents with left lower quadrant pain. *Sigmoid volvulus* - CT shows the classic **coffee bean sign** with a dilated, twisted sigmoid loop and **whirl sign** at the point of torsion. - Presents with severe **colicky abdominal pain**, distension, and **obstipation** (inability to pass gas or stool).

Q: 'Rim' and 'ball' nephrograms in intravenous urography are seen in which condition?

Chronic obstructive nephropathy. **Explanation:** The correct answer is **Chronic obstructive nephropathy**. This phenomenon occurs during Intravenous Urography (IVU) due to long-standing hydronephrosis. **1. Why Chronic Obstructive Nephropathy is correct:** In chronic obstruction, the renal pelvis and calyces are massively dilated, leading to severe thinning of the renal parenchyma. * **Rim Nephrogram:** This represents the thin shell of remaining functional renal parenchyma (cortex and medulla) being opacified by contrast, surrounding the dilated, non-opacified calyces. * **Ball Nephrogram:** This occurs when the contrast eventually enters the dilated, clubbed calyces, appearing as rounded "balls" of opacification. **2. Why the other options are incorrect:** * **Normal kidneys:** A normal nephrogram is uniform and homogenous, appearing within 1 minute of contrast injection, followed by rapid excretion into the pelvicalyceal system. * **Acute obstructive nephropathy:** This typically presents with an **"Increasingly Dense Nephrogram."** The kidney is swollen, and contrast accumulates in the tubules because of high intratubular pressure, but it is not excreted promptly. * **Chronic renal failure:** In end-stage renal disease, the kidneys are usually small and shrunken with poor contrast uptake, leading to a **faint or absent nephrogram**. **3. Clinical Pearls for NEET-PG:** * **Negative Pyelogram:** In the early phase of IVU in chronic obstruction, the dilated, water-filled calyces appear as lucent areas against the opacified parenchyma. * **Crescent Sign:** A high-yield finding in hydronephrosis where contrast is concentrated in collecting tubules that have been displaced and flattened into a crescent shape by dilated calyces. * **Delayed Films:** In cases of obstruction, delayed films (up to 24 hours) are essential to visualize the site of obstruction.

Q: A 64-year-old man develops increasing dysphagia over many months. A barium swallow is performed. What is the most likely cause of his clinical presentation?

Carcinoma of the esophagus. ***Carcinoma of the esophagus*** - Progressive dysphagia in a **64-year-old male** with **irregular narrowing** and **shouldering/apple-core appearance** on barium swallow is characteristic of **esophageal carcinoma**. - The **rat-tail sign** and abrupt transition from normal to narrowed esophagus strongly suggests malignant stricture rather than benign causes. *Achalasia* - Typically presents with **bird-beak appearance** on barium swallow showing smooth, symmetrical tapering at the gastroesophageal junction. - Characterized by **failure of lower esophageal sphincter relaxation** with associated **esophageal dilatation** proximal to the obstruction. *Sliding hiatal hernia* - Shows **gastroesophageal junction displacement** above the diaphragm with a **bell-shaped** or **tulip-shaped** appearance on barium swallow. - Usually causes **gastroesophageal reflux symptoms** rather than progressive mechanical dysphagia seen in this case. *Paraoesophageal hernia* - Demonstrates **herniation of gastric fundus** alongside the esophagus while the **gastroesophageal junction remains below the diaphragm**. - Typically presents with **chest pain** and **early satiety** rather than progressive dysphagia, and shows characteristic **upside-down stomach** appearance.

Q: Tear-drop bladder is seen in which of the following conditions?

Perivesical hemorrhage with rupture. ### Explanation **Concept:** A **Tear-drop bladder** (also known as a pear-shaped or gourd-shaped bladder) is a radiologic sign seen on a cystogram or CT scan. It occurs when the bladder is compressed from both sides by extrinsic pressure, causing it to elongate vertically. **Why Option C is Correct:** In the context of trauma, a **perivesical (pelvic) hematoma** is the most common cause. When a pelvic fracture occurs, it can lead to significant hemorrhage in the space of Retzius. This bilateral accumulation of blood and fluid (often associated with **extraperitoneal bladder rupture**) compresses the bladder from the lateral aspects, forcing it into a narrow, vertical "tear-drop" configuration. **Why Other Options are Incorrect:** * **Tuberculosis (Option A):** Genitourinary TB leads to a **"Thimble bladder"** (a small, shrunken, fibrotic bladder with low capacity) due to extensive scarring, not extrinsic compression. * **Hunner’s Ulcer (Option B):** This is a classic finding in **Interstitial Cystitis**. While it causes a painful, low-capacity bladder, it does not produce the tear-drop shape. * **Perivesical hemorrhage without rupture (Option D):** While a hematoma alone can compress the bladder, the classic "tear-drop" sign in surgical trauma questions is most frequently associated with the combination of pelvic fracture, hematoma, and **bladder rupture** (specifically extraperitoneal). **NEET-PG High-Yield Pearls:** * **Differential Diagnosis for Tear-drop Bladder:** 1. Pelvic hematoma (Trauma - Most Common). 2. Pelvic Lipomatosis (Non-traumatic, bilateral fat deposition). 3. Bilateral iliac artery aneurysms. 4. Pelvic lymphadenopathy or massive psoas hypertrophy. * **Christmas Tree Bladder:** Seen in Neurogenic bladder (detrusor-sphincter dyssynergia). * **Thimble Bladder:** Seen in Tuberculosis and Schistosomiasis.

Q: Which of the following is the most sensitive imaging modality for the diagnosis of idiopathic chronic pancreatitis (IOC)?

Contrast-enhanced Computed Tomography (CT). **Explanation:** **Contrast-enhanced Computed Tomography (CT)** is the investigation of choice and the most sensitive imaging modality for diagnosing chronic pancreatitis among the given options. The diagnosis of chronic pancreatitis relies on identifying structural changes in the pancreatic parenchyma and ductal system. CT is highly effective at detecting the classic triad of chronic pancreatitis: **pancreatic calcifications** (the most specific sign), **ductal dilatation**, and **parenchymal atrophy**. It also helps in identifying complications like pseudocysts, portal vein thrombosis, and arterial pseudoaneurysms. **Why other options are incorrect:** * **Ultrasound (USG):** While often the initial screening tool, USG is operator-dependent and frequently limited by overlying bowel gas. It is less sensitive than CT for detecting subtle calcifications or early parenchymal changes. * **Serum Lipase and Amylase:** These are biochemical markers used for **Acute Pancreatitis**. In chronic pancreatitis, the progressive destruction of acinar tissue often leads to normal or even low levels of these enzymes; therefore, they have no diagnostic value for chronic disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most specific sign of Chronic Pancreatitis:** Pancreatic calcifications. * **Gold Standard for early/subtle changes:** Endoscopic Ultrasound (EUS) or Secretin-enhanced MRCP (though CT remains the practical first-line diagnostic imaging). * **Chain of Lakes appearance:** Refers to the beaded appearance of the main pancreatic duct due to multiple strictures and dilatations, best seen on MRCP or ERCP. * **Most common cause:** Alcohol abuse (Chronic), whereas Gallstones are the most common cause of Acute Pancreatitis.

Q: Which of the following is NOT a radiological feature of sigmoid volvulus?

Cupola sign. **Explanation:** **Sigmoid Volvulus** is a common cause of large bowel obstruction occurring when the sigmoid colon twists on its mesenteric axis. **Why the Cupola Sign is the Correct Answer:** The **Cupola sign** is a radiological feature of **pneumoperitoneum** (perforated viscus), not volvulus. It refers to an arcuate lucency seen on a supine chest or abdominal radiograph, representing air trapped under the central tendon of the diaphragm. **Analysis of Incorrect Options (Features of Sigmoid Volvulus):** * **Inverted U-shaped loop:** This is the classic appearance of the massively dilated sigmoid colon, which loses its haustrations and rises out of the pelvis, often reaching the diaphragm. * **Liver Overlap Sign:** This occurs when the gas-distended sigmoid loop extends superiorly and overlaps the liver shadow. This helps differentiate sigmoid volvulus from cecal volvulus (where the cecum usually stays to the left and does not overlap the liver). * **Bird of Prey Sign:** Seen on a **Barium Enema**, it represents the tapering of the contrast at the site of the twist, resembling a bird's beak or "ace of spades." **NEET-PG High-Yield Pearls:** * **Coffee Bean Sign:** The most common X-ray sign of sigmoid volvulus (the two walls of the dilated loop form the "cleft" of the bean). * **Frimann-Dahl Sign:** Three dense lines (the walls of the sigmoid) converging toward the site of obstruction in the pelvis. * **Whirl Sign:** The pathognomonic finding on **CT scan**, representing the twisting of the mesentery and vessels. * **Management:** Initial treatment is usually endoscopic detorsion (Rigid Proctosigmoidoscopy) unless gangrene is suspected.

Q: Radiography of which of the following renal stones shows opacity, EXCEPT?

Uric acid. **Explanation:** The visibility of renal stones on a plain X-ray (KUB) depends on their **atomic number** and **density** relative to surrounding tissues. Stones containing calcium are radiopaque, while those lacking heavy elements are radiolucent. **Why Uric Acid is the Correct Answer:** Uric acid stones are composed of organic compounds with low atomic numbers. They do not contain calcium or other heavy minerals, making them **radiolucent** on conventional radiography. They are typically visualized using Ultrasound or Non-Contrast Computed Tomography (NCCT), where they appear hyperdense. **Analysis of Incorrect Options:** * **Oxalate (Calcium Oxalate):** These are the most common renal stones. Due to their high calcium content, they are **highly radiopaque** and easily seen on X-ray. * **Cystine:** These stones contain sulfur atoms. While they are less dense than calcium stones, they are **faintly radiopaque** (often described as having a "ground-glass" appearance). * **Struvite (Triple Phosphate):** Composed of Magnesium Ammonium Phosphate, these often form "staghorn" calculi. They contain enough mineral content to be **radiopaque**, though usually less so than pure calcium oxalate. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Radiolucent Stones (SULI):** **S**ulfonamides, **U**ric acid, **L**euvonir/Indinavir (HIV drugs), **I**ndinavir. * **Gold Standard Investigation:** Non-Contrast CT (NCCT) is the investigation of choice for all renal stones as it can detect almost all types, including radiolucent uric acid stones (except Indinavir stones). * **Pure Matrix stones** are also radiolucent. * **Cystine stones** are unique for being hexagonal on microscopy and faintly opaque on X-ray.

Q: A 26-year-old male presents with abdominal pain and episodes of hematuria. His blood pressure is 160/100 mm Hg and is refractory to standard antihypertensive drugs. Renal Doppler shows a parvus tardus pattern. Subsequent CT renal angiogram was performed. This condition, as depicted, may occur in all of the following except?

Polyarteritis nodosa (PAN). ***Polyarteritis nodosa (PAN)*** - **PAN** typically causes **microaneurysms** and **necrotizing vasculitis** in medium-sized arteries, not stenotic lesions that would produce **parvus tardus** waveforms. - The **parvus tardus pattern** indicates **proximal renal artery stenosis**, which is not characteristic of PAN's pathophysiology involving aneurysmal dilatation rather than narrowing. *Atherosclerosis* - **Atherosclerotic plaques** commonly cause **renal artery stenosis**, especially at the **ostium**, leading to renovascular hypertension and **parvus tardus** waveforms. - This is the most common cause of **renal artery stenosis** in patients over 50 years, though can occur in younger patients with risk factors. *Fibromuscular dysplasia (FMD)* - **FMD** is a leading cause of **renal artery stenosis** in young adults, particularly women, causing the classic **"string of beads"** appearance on angiography. - The **medial fibroplasia** variant creates alternating areas of stenosis and dilatation, resulting in **parvus tardus** waveforms downstream from the stenotic segments. *Takayasu arteritis* - This **large vessel vasculitis** commonly involves the **renal arteries**, causing stenosis through inflammatory wall thickening and fibrosis. - **Takayasu arteritis** can present with **renovascular hypertension** and **parvus tardus** patterns, particularly in young Asian women with systemic inflammatory symptoms.

Question 1

An adult male presented with abdominal pain and diarrhea. A Barium meal follow-through revealed a mildly narrowed lumen of a loop with stretched and fixed rigid walls. A CT contrast study showed a stellate-shaped, enhancing mesenteric lesion with adjacent bowel wall thickening. What does this mass lesion represent?

Accepted Answer

Mesenteric carcinoid tumor

Answer

Jejunal adenocarcinoma

Answer

Lymphoma

Answer

Liposarcoma

Question 2

A plain radiograph of the chest and abdomen shows findings suggestive of which of the following conditions?

Accepted Answer

Pneumoperitoneum

Answer

Pleural effusion

Answer

Pneumonia

Answer

Volvulus

Question 3

A 51-year-old male presents with blood-stained stools and abdominal pain. Based on the image shown, what is the most likely diagnosis?

Accepted Answer

Intussusception

Answer

Crohn's disease

Answer

Diverticulosis

Answer

Sigmoid volvulus

Question 4

'Rim' and 'ball' nephrograms in intravenous urography are seen in which condition?

Accepted Answer

Chronic obstructive nephropathy

Answer

Normal kidneys

Answer

Acute obstructive nephropathy

Answer

Chronic renal failure

Question 5

A 64-year-old man develops increasing dysphagia over many months. A barium swallow is performed. What is the most likely cause of his clinical presentation?

Accepted Answer

Carcinoma of the esophagus

Answer

Achalasia

Answer

Sliding hiatal hernia

Answer

Paraoesophageal hernia

Question 6

Tear-drop bladder is seen in which of the following conditions?

Accepted Answer

Perivesical hemorrhage with rupture

Answer

Tuberculosis

Answer

Hunner's ulcer

Answer

Perivesical hemorrhage without rupture

Question 7

Which of the following is the most sensitive imaging modality for the diagnosis of idiopathic chronic pancreatitis (IOC)?

Accepted Answer

Contrast-enhanced Computed Tomography (CT)

Answer

Ultrasound (USG)

Answer

Serum lipase level

Answer

Serum amylase level

Question 8

Which of the following is NOT a radiological feature of sigmoid volvulus?

Accepted Answer

Cupola sign

Answer

Inverted U shaped bowel loop

Answer

Liver overlap sign

Answer

Bird of prey sign

Question 9

Radiography of which of the following renal stones shows opacity, EXCEPT?

Accepted Answer

Uric acid

Answer

Oxalate

Answer

Cystine

Answer

Struvite

Question 10

A 26-year-old male presents with abdominal pain and episodes of hematuria. His blood pressure is 160/100 mm Hg and is refractory to standard antihypertensive drugs. Renal Doppler shows a parvus tardus pattern. Subsequent CT renal angiogram was performed. This condition, as depicted, may occur in all of the following except?

Accepted Answer

Polyarteritis nodosa (PAN)

Answer

Atherosclerosis

Answer

Fibromuscular dysplasia (FMD)

Answer

Takayasu arteritis

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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